INSIDE THE ISSUE

> Massachusetts Ranks #1
> Congress on Prior Authorizations
> Opioid Overdoses
> Temporary M.D. Licenses
> Hospitals Confront Violence
> Easing Hospital Pressures
> Social Needs Measures
> Transitions at BMC, MEE

MONDAY REPORT

Through COVID, Massachusetts Had the Best Healthcare System in the U.S.

Where is a patient most likely to receive high-quality, accessible, and equitable healthcare? In Massachusetts, according to the highly respected Commonwealth Fund’s most recent Scorecard on State Health System Performance.

Using 58 measures of healthcare access, quality, use of services, costs, health disparities, reproductive care and women’s health, and health outcomes, the Commonwealth Fund found that Massachusetts ranked first among 50 states and D.C. Hawaii and New Hampshire rounded out the top three; Oklahoma, West Virginia, and Mississippi were at the bottom of the rankings.

Of particular note, Massachusetts had the lowest rate of deaths from preventable and treatable causes between 2019 and 2021 – the height of the COVID-19 pandemic.

“Delivering healthcare has never been more difficult than over the past few years,” said MHA President & CEO Steve Walsh. “It is an extraordinary distinction for the commonwealth to rank first in these metrics through it all. Behind the data are our patients, and the fact that Massachusetts ranked highest in preventing avoidable deaths is something in which every caregiver can take enormous pride. As conversations around the future healthcare accelerate, it is essential that we leverage the same focus and collaboration that got us to where we are today.”

Massachusetts ranked Number 1 in the Access and Affordability measure, as well as in the Reproductive & Women’s Health, Prevention & Treatment, Healthy Lives, and Racial & Ethnic Health Equity categories.

Bipartisan Congressional Effort on Prior Authorization Changes

Members of Congress from both parties and both chambers joined last week to sign House and Senate letters urging the Biden Administration to further streamline the prior authorization (PA) process that is currently the subject of federal rulemaking.

The Centers for Medicare and Medicaid Services (CMS) issued proposed rules in December 2022 that would require Medicare Advantage plans and Medicaid managed care programs, among others, to speed up prior auth decisions, establish an electronic decision process to cut down on paperwork, and increase transparency around how the prior authorization decisions are reached. The rules implement the bipartisan Improving Seniors’ Timely Access to Care Act that was signed into law last year.

The letters from Congress last week praised CMS for its efforts, but say they don’t go far enough. Specifically, the legislators call on CMS to expand on the “e-PA” automation proposal by “incorporating a mechanism for real-time decisions for routinely approved items and services.”

And while the proposed CMS rule addresses the main concern from providers about delays from insurers in reaching PA decisions, members of Congress say the proposed 72-hour timeframe is still too long. “We are concerned that delaying care for up to three days could jeopardize a patient’s life, health, or ability to regain maximum function,” the letters read, adding that a response within 24 hours should be the norm. Congress also asks for “detailed transparency metrics” to help understand how health insurance companies reach their decisions.

Massachusetts Senators Elizabeth Warren and Ed Markey signed the Senate letter, and Representatives Stephen Lynch, Lori Trahan, Jake Auchincloss, Jim McGovern, Seth Moulton, and Bill Keating signed the House letter.

Overdose Deaths Rose in 2022; Supervised Consumption Sites Gain Favor

The Department of Public Health (DPH) reported last Thursday that there were 2,357 confirmed and estimated opioid-related overdose deaths in 2022 – a 2.5% increase over 2021 and a 9% increase since 2016.

In 2023 (January through March), there have been 522 confirmed and estimated opioid-related deaths. (Estimated deaths use predictive modeling techniques for all cases not yet finalized by the Office of the Chief Medical Examiner.)

Among non-Hispanic Black residents, the opioid-related overdose death rate increased by 42% from 2021 to 2022. The rate for non-Hispanic Black women increased by 47%. Those groups saw the largest increases.

“We have to lean into the disparities we see in impacts on Black residents and target our interventions accordingly,” said Secretary of Health and Human Services Kate Walsh. “Challenges like housing, hunger, and accessing education, behavioral health treatment, and transportation need to be addressed in concert with substance use treatment in order to turn the tide of this epidemic.”

According to the DPH report, the state was able to perform toxicology screenings on 2,160 of the total deaths in 2022. That testing showed that fentanyl was present in 93% of the cases. “Fentanyl increased dramatically through the second quarter 2016 and has increased at about 1% per quarter ever since,” according to the report. DPH says most of the fentanyl found in Massachusetts is “illicitly produced” and not diverted from the pharmaceutical supply chain.

MHA and its membership have been active in efforts to curb the opioid-use trend over the years. MHA has produced nationally recognized guidance on how to dispense opioids in hospitals and emergency departments, has advocated successfully for more funding for treatment, and more.

“This new DPH data is a stark reminder of an epidemic that was devastating our communities long before the pandemic arrived,” said Leigh Simons, MHA’s senior director, Healthcare Policy. “This crisis is evolving, and so must our approach. Massachusetts hospitals and health systems remain committed to being a central part of the solution, which we know will require an even more intense focus on substance use prevention, harm reduction, and deep-rooted health inequities. Governor Healey and Secretary Walsh have been at the forefront of this epidemic since it began, and we are confident that they will lead with the type of bold actions it will take to turn the tide. MHA and our members will continue to work with the administration to help ease this public health crisis once and for all.”

One such action from the administration is a new study to investigate the use of “safe consumption sites” where individuals can use illicit drugs under the supervision of caregivers and without legal consequences. Last week, as reported in State House News Service, DPH Commissioner Robbie Goldstein did not endorse such sites, but said “we want to understand the feasibility of overdose prevention sites” in Massachusetts. While having the state operate such sites is an idea that has been floated in the past, a previous U.S. Attorney in Massachusetts, Andrew Lelling, in 2018 indicated he would prosecute any attempt to do so as a violation of federal law.

MHA is part of the Massachusetts for Overdose Prevention Centers Coalition that advocates for passage of legislation H.1981/S.1242 that among other things would create a 10-year pilot program for such controlled use sites. The bills’ chief sponsors are Representatives Dylan Fernandes and Marjorie Decker, and Senator Julian Cyr.

M.D. Temporary Licenses to Expire September 30

The Board of Registration in Medicine (BORIM) has announced that the emergency temporary licenses it authorized for physicians during the COVID-19 pandemic will expire on September 30, 2023.

The emergency licenses were critical for the healthcare sector’s response to the pandemic. But with the end of the public health emergency, BORIM says the emergency licenses are ending as well and that there will not be any further extensions.

Those holding emergency temporary licenses can convert to a full license to practice in Massachusetts by submitting an application form and fee ($600) to BORIM before September 30. Physicians who submit their application by the deadline will be given a grace period in which they may continue to practice after the September 30 until BORIM completes its full-license review. Doctors with a temporary license who do not submit a full-license application in time cannot treat patients in Massachusetts beginning October 1, 2023.

Workplace Violence: Hospitals Crack Down

Heywood Healthcare, where a registered nurse this month was attacked by a patient, last week instituted new campus-wide protections for its workers.

At a press conference last Monday where co-Chief Executive Officer Roz Penney implored the public to treat healthcare workers with respect, the system announced that weapons of any kind will not be permitted on any of its premises.

“To be clear, we are not doing this to make a political statement or to start a debate,” Penney said. “We are doing this because every single person who chose as their line of work to take care of people when they are sick deserves to go home to their children, their spouses, parents, siblings, and friends at the end of their shift, unharmed.”

In January, MHA released a report – An Untenable Situation & A Call to Protect the Workforce – showing that every 38 minutes in a Massachusetts healthcare facility, someone – most likely a clinician or employee – is either physically assaulted, endures verbal abuse, or is threatened. The MHA Board of Trustees in January endorsed the United Code of Conduct Principles that is included in the report, and which include measures to promote a safe and respectful environment, examples of what potential violations look like, proposed consequences for violations, and recommendations for maintaining the principles long-term.

Other actions Heywood has taken include screening all patients entering the ED area with a security wand; providing a gown to all patients in the ED upon entry (unless deemed not appropriate); restricted visitation; and working with local law enforcement to secure regular police details. Heywood also instituted a new Code of Conduct; implemented the “alertus” safety management software platform, which is a critical incident notification system; and ordered metal detectors for each campus.

At Baystate Health last week, the system also instituted a Patient and Visitor Code of Conduct based on the MHA Board-approved language. Baystate Health expects all doctors, nurses, and other employees to treat patients and visitors with respect and courtesy, and they expect guests to do the same to their employees.

The Baystate code prohibits:

• Threatening, abusive, aggressive, bullying, or violent language or behavior;
• Discriminatory, disrespectful, harassing, or offensive language or behavior;
• Swears, slurs or remarks targeting another’s age, race, ethnicity, religion, culture, disability, language, sexuality or sexual orientation, gender identity, socioeconomic status, marital status, or ancestry;
• Possession of weapons, explosives, or firearms on Baystate property or in any Baystate Health facility;
• Possession or use of alcohol, tobacco, marijuana, medical marijuana, or illegal drugs on Baystate Health property or in any Baystate Health facility;
• Disruption of other patients’ care or experience; and
• Taking photos or videos of patients, visitors, and/or staff without permission.

New Family Welcome Centers & Shelters Relieve Pressures on Hospitals

Last Friday, the Healey Administration announced it was opening the first Family Welcome Center in Allston to serve as an entry point for newly arrived migrant families to be connected to social services and shelter, specifically on the weekends when state offices are closed. Officials will also be opening a temporary shelter site at Joint Base Cape Cod. The Joint Base shelter will be able to receive 16 families but could be expanded to 60 families in the future, the administration said. Additional welcome centers will be opened in other areas of the state in the months ahead.

Governor Healey has activated 50 Massachusetts National Guard personnel to support the shelter operations at Joint Base Cape Cod.

As the number of migrant families and patients seeking safe haven in the commonwealth continues to increase, emergency departments and outpatient centers across the state have often served as places of refuge. While hospitals strive to meet the basic needs of folks who have often experienced significant trauma prior to their presentation and require both medical and non-medical services, this humanitarian crisis has placed greater strain on a system that is already experiencing workforce shortages and intense capacity constraints. Now the Family Welcome Centers will be able to provide basic necessities, such as food, baby formula, and diapers – with cultural competency – while having the resources to connect families to the Department of Transitional Assistance programs, MassHealth, and other supports.

Electronic Clinical Quality Measure: Addressing Social Needs

CMS has contracted with Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (CORE) to develop a re-designed measure of screening for social needs (food insecurity, housing insecurity, transportation insecurity, and utility insecurity). The re-designed measure will be an electronic clinical quality measure (eCQM) evaluating hospitals on screening and following-up on social needs of patients. As part of its measure development process, CORE requests that interested parties submit comments on the candidate or concept measures that may be suitable for this project. The primary objective of this project is to evaluate how hospitals address social needs that affect health, such as food insecurity, housing insecurity, transportation barriers, and affordability of utilities. The comment period ends July 2. Learn more here.

Transitions

Alastair Bell, M.D. has been named CEO of Boston Medical Center Health System. Bell was named president of the system in November 2022 and has been serving as interim CEO since March when his predecessor Kate Walsh was appointed Secretary of Health and Human Services. He received a Doctor of Medicine from the University of Oxford in England, a Master of Arts in physiology from the University of Cambridge in England, and an MBA from Harvard Business School.

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CarolAnn Williams has been named president of Mass Eye and Ear (MEE). She has served as interim president since December 2022, succeeding John Fernandez. She first joined the hospital in 2011, serving as vice president of finance and CFO. She was part of the hospital team that led the acquisition of MEE by Mass General Brigham in 2017-18.

John LoDico, Editor